Care vs. Coverage – a Better Solution

Let’s think outside the insurance box. Let’s focus on care rather than “coverage.” Let physicians show that we are going to be part of the solution.

[Editor’s Note: This article was contributed by Alieta Eck, MD. Dr. Eck graduated from the Rutgers College of Pharmacy and the St. Louis University School of Medicine. She has been in private practice with her husband, Dr. John Eck, MD since 1988.]

“This clinic saved my life.” So said the pleasant 50-something year old woman on the exam table. “I had dangerously high blood pressure and needed medicine. I signed up for ObamaCare and then went through the list of 37 physicians who supposedly take it.”

No office would give her an appointment. She went to the emergency room, got a few days’ worth of meds and the ER physician suggested that she go to the Zarephath Health Center. “They will help you.” This was about two years ago and this grateful patient has been coming to see us ever since. She has a job that barely pays for her rent and groceries, and she has a plastic Medicaid card that supposedly is all she needs to get medical care. But it is clearly not living up to its promise.

The Zarephath Health Center in central New Jersey opened its doors in 2003 with the goal of providing care to those who could not pay. One half of the patients we see have Medicaid, the government “insurance” that covers the poor, expanded from 1 million to 2 million under ObamaCare in NJ. We see 40-50 patients in the 12 hours we are open each week. The cost to provide care is $15 per patient visit and none comes from the taxpayer. The federal government provides medical malpractice coverage for the care we provide in the free clinic, freeing us to provide good but not excessive or “defensive” care.

New Jersey Senator Joseph Vitale (D) is castigating the Republicans for wanting to repeal ObamaCare, citing the 700,000 new Garden State residents who are newly insured. Trump wants the states to have more flexibility and control, to create a freer and more open medical market. But Senator Vitale calls that code for “we really don’t care what happens to your people.” He stated that the repeal of ObamaCare would require New Jersey to become “tighter, smarter but also crueler.”

Crueler? Ask the patients we see at the ZHC. Ask those who are in need of psychiatric medicines who cannot find a psychiatrist to prescribe them. Ask patients who are in persistent chronic pain from documented spinal stenosis, or gunshot pellets that remain in the knee joint because the patient cannot find a surgeon to remove them. Ask the woman with symptomatic gallstones who cannot find a surgeon to take her gallbladder out. Going to the emergency room gets her a few days of painkillers, as the gallbladder is not considered an emergency–yet–unless there are already abnormal liver tests, a fever, or an elevated white blood cell count. Calling the office of a surgeon with her Medicaid card does not get her an appointment. It is the Medicaid program that can be very cruel.

If those Medicaid dollars came to New Jersey as a block grant, unencumbered with costly, counterproductive federal rules, the State could come up with something better than the current system that so often disappoints. Can’t our lawmakers demonstrate any creativity? Why not come up with a system that will truly save money and increase access to care? It now requires a federal waiver to innovate, and Obama’s Center for Medicare and Medicaid Services was very reluctant to grant waivers.

The question for Senate Health Committee Chairman Vitale is this: “Is it better for a patient to have a plastic card that costs the taxpayers $5,000 while still having to go to the emergency room to see a doctor, or is it better to have a place where people can simply be seen?”

State lawmakers have a chance to solve the problem of access to care. Instead of a one-size-fits all “universal healthcare system,” why not allow people to buy the care and insurance they think is best for them? This will allow a thriving market that offers many choices to develop. Costs will become much more affordable for all. And for those who still cannot afford care and insurance, states would do well to encourage a system of many non-government free clinics full of kind volunteers and physicians of all specialties. New Jersey lawmakers have written bill S239, the “Volunteer Medical Professional Health Care Act,” where physicians and nurses of all specialties can donate four hours per week in free care in exchange for the state providing medical malpractice protection in their private practices.

Senator Vitale is unwilling to bring this plan up for discussion and vote.

Let’s think outside the federal insurance box. Let’s focus on care rather than “coverage.” Let physicians show how much we are willing to be part of the solution, donating our time and expertise to care for those who cannot pay. Physicians would be much better able to do this if not saddled with the high cost of the government-created liability system.

Look at the numbers: $5,000 for every beneficiary–which does not buy psychiatric care, or hypertension treatment, or gall bladder surgery. (Dare we ask what it does buy?) How much protection against professional liability would that buy?

And look at the human side: red tape and denial of care versus compassionate care that patients need–at the time that they need it.